Pediatr Crit Care Me
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Pediatr Crit Care Me · Oct 2020
Multicenter StudyRacial/Ethnic Minority Children With Cancer Experience Higher Mortality on Admission to the ICU in the United States.
We investigated whether differences in survival exist between children of various racial/ethnic groups with cancer admitted to the PICU. ⋯ The results show that after controlling for severity and cancer type, a child's race, ethnicity, and region of presentation influence mortality in the PICU. This suggests that additional investigation is warranted along with a need to rethink our approach to the evaluation and treatment of critically ill African American and Hispanic children with cancer.
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Pediatr Crit Care Me · Oct 2020
Paved With Good Intentions: Hospital Visitation Restrictions in the Age of Coronavirus Disease 2019.
Hospital visitation restrictions have been widely implemented during the coronavirus disease 2019 pandemic as a means of decreasing the transmission of coronavirus. While decreasing transmission is an important goal, it is not the only goal that quality healthcare must aim to achieve. Severely restricted visitation policies undermine our ability to provide humane, family-centered care, particularly during critical illness and at the end of life. ⋯ Using our experience in a PICU, we survey the shortcomings of current visitation restrictions. We argue that hospital visitation restrictions can be implemented in ways that are nonmaleficent, but this requires unwavering acknowledgment of the value of social and familial support during illness and death. We advocate that visitation restriction policies be implemented by independent, medically knowledgeable decision-making bodies, with the informed participation of patients and their families.
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Pediatr Crit Care Me · Oct 2020
Deployment of a Clinical Pathway to Improve Postcardiac Arrest Care: A Before-After Study.
Postcardiac arrest care bundles following adult cardiac arrest are associated with improved survival to discharge. We aimed to evaluate whether a clinical pathway and computerized order entry were associated with improved pediatric postcardiac arrest care and discharge outcomes. ⋯ After controlling for known potential confounders, the creation and deployment of a postcardiac arrest care pathway and computerized order entry set were not associated with improvement in pathway adherence or overall outcomes, but was associated with increased survival to hospital discharge for children with in-hospital cardiac arrests.
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Simulation-based education is used in the U.S. Pediatric Critical Care Medicine fellowship programs, yet the prevalence and types of simulation used is unknown. A survey was developed to determine the prevalence, the perceived importance, and barriers associated with simulation-based education in these programs. ⋯ Nearly, all responding U.S. Accreditation Council for Graduate Medical Education-accredited Pediatric Critical Care Medicine fellowship programs use simulation-based education to train Pediatric Critical Care Medicine fellows with the majority perceiving simulation as absolutely necessary to Pediatric Critical Care Medicine fellow training. The reported types of simulation used in fellow training varied, as did training theories and concepts in the simulation programs. More research is needed to understand how to optimize and perhaps standardize parts of Pediatric Critical Care Medicine fellowship simulation training to improve the impact and outcomes of such training.